Over-the-Counter (OTC) Catalog Get the OTC items you need.

2015 Over-the-Counter (OTC) Catalog Get the OTC items you need. Medicare Advantage Plans H5087_CA027266_WCM_OTC_ENG CMS Accepted 08302014 WellCare 2014 CA_07_14_EC EC5OTCCAT60343E

The Benefits of Easy Choice Health Plan Add Up. What is Easy Choice s OTC benefit? Simply put, we give you a monthly dollar amount; you spend it on some of the over-the-counter (OTC) items you use every day. It s that easy. The OTC benefit is part of your health plan. Every month you can get brand-name or generic OTC medications and products like bandages, pain relievers, cold medicine, toothpaste, vitamins and much more. You can use this catalog, then order online or by phone, and we ll ship your items right to your door. Each plan offers different OTC benefit amounts. Check your Evidence of Coverage or Summary of Benefits for your specific benefit amount for your plan. Remember that your benefit and items are only for your use. Use your benefit each month. It does not roll over to the next month. How Do I Use My OTC Benefit? There are a couple of ways to get your items. No matter how you order them, we ll ship them right to your door. It s that easy. Allow 7-10 days to receive your order. Find the items you want in this catalog, then: 1. Give us a call at 1-877-483-9563, TTY 711, Monday-Friday, 6:30 a.m. 8:00 p.m. Pacific. 2. Visit us at www.easychoicehealthplan.com. Log in using your member ID number and date of birth. You can find your member ID number on your Easy Choice member ID card. Call Customer Service to order your OTC items 1 EC5OTCCAT60343E

What Can I Order With My OTC Selection? Eligible items On the next few pages, you ll find a list of products. These are the items that you can order from us and have mailed to your home. Eligible items include but are not limited to: fiber supplements, first aid supplies, medicines, ointments, sprays with active medical ingredients that alleviate symptoms, topical sunscreen, supportive items for comfort such as knee braces and adult incontinence products, and mouth care such as dental floss and toothbrushes. Dual-purpose items What are dual-purpose items? They re medicines and products that can be used for either a medical condition or for general health and well-being. You can get dual-purpose items as part of your OTC benefit if you use them to treat a specific medical condition and your doctor recommends the product or medicine. Talk with your doctor before buying dual-purpose items. For your convenience, we ve marked dual-purpose items with a ( ). Dual-purpose items include but are not limited to: Minerals and vitamins In-home testing and monitoring Hormone replacement Weight-loss items Some items, under certain circumstances, may be covered under either Part B or Part D. For example, gauze may be covered under Part B when it is being used, as prescribed, to perform surgical wound dressing changes. For your convenience, we ve marked these items with a (**). What s not eligible? The following categories and items listed are not eligible for the OTC benefit. You cannot order them from us, and if you buy these items at a store, we can t repay you for them. Non-eligible items include but are not limited to: Alternative medicines such as botanicals, herbals, probiotics and nutraceuticals Baby items such as diapers and formula Contraceptives such as birth control pills and spermicides Convenience and comfort items such as scales, fans and magnifying glasses Cosmetic items such as mouthwash, bad breath remedies, deodorants and teeth whitening Food products or supplements Replacement items such as hearing aid batteries and contact lens containers 2 Call Customer Service to order your OTC items

Items You Can Order From Us Do you prefer lower-cost generics or familiar brand-name products? Your OTC benefit lets you make the choice! Look over the list of eligible items on the next few pages. You can order online or by calling us and telling us the items you want. We ll send them to your home and deduct the amount from your monthly benefit. ID# OUR CATALOG ITEMS ACNE TREATMENT 1241389 Benzoyl Peroxide Gel Benzoyl Peroxide Gel 45gm $3.50 10% 10% ALLERGY 1498302 Cold & Allergy PE Cold & Allergy PE 24ct $3.50 2152874 Diphenhydramine Benadryl Allergy 100ct $4.50 2118297 25mg Capsules Softgels Dye Free 24ct $6.50 3595196 Nasal Spray 1oz $6.50 1200021 Afrin Nasal Spray Original 0.5oz $7.50 Loratadine 10mg Loratadine 10mg 4242327 30ct $4.00 Loratadine 10mg Loratadine 10mg 4257457 100ct $12.00 4264792 Saline Nasal Spray 1.5oz $3.50 4764163 Ocean Nasal Spray 1.5oz $4.50 Cetirizine 10mg 4595054 30ct $11.50 Zyrtec OTC Adult 4014296 10mg 24-Hour Tab 5ct $9.00 Sinus & Allergy PE Sinus & Allergy PE 7850068 24ct $3.50 Afrin Nasal Spray Afrin Nasal Spray 0.5oz 2155083 Sinus Sinus 0.5oz $7.50 Allegra OTC 180mg Allegra OTC 180mg 15ct 4330601 24-Hour 24-Hour 15ct $19.00 Allegra OTC 60mg 12-Hour 12ct 4330668 * = Quantities and brands may vary depending upon availability. = Dual-purpose items ** = Covered under either Part B or Part D Allegra OTC 60Mg 12-Hour 12ct $13.50 Call Customer Service to order your OTC items 3

ANTACID / ACID REDUCERS Antacid (Antigas) Antacid (Antigas) 2804144 100ct $4.00 80mg 80mg 2163913 Antacid Assorted Tums 150ct $3.50 1336700 Regular Assorted Fruit 150ct $6.50 2311934 Antacid Chewable Extra Strength 96ct $3.50 Tums Extra Strength 1469030 Assorted 96ct $6.50 2164309 Antacid Liquid DS 12oz $4.50 Antacid Liquid DS Antacid Regular Antacid Regular 3203700 12oz $4.50 Strength Liquid Strength Liquid Effervescent Pain 9900148 Relief 36ct $5.00 1189422 Alka-Seltzer Original 24ct $5.00 4288551 Famotidine 10mg Famotidine 10mg 70ct $11.00 4305173 Famotidine Pepcid AC 30ct $6.00 3434321 10mg Original Strength 30ct $13.50 Gas Relief Softgel 2967776 Extra Strength 30ct Gas-X Extra Strength $6.00 2435568 Softgels 10ct $3.50 2164325 Milk of Magnesia 12oz $4.00 Milk of Magnesia 1006741 Pink Bismuth Liquid 8oz $3.50 Pepto-Bismol Liquid 1099829 Original 8oz $5.50 Pink Bismuth - 2236560 Chewable 30ct $3.50 2189959 Pepto-Bismol Caplets Original 40ct $9.50 Ranitidine 75mg 4938775 30ct $5.00 2508752 Zantac 75mg 30ct $13.00 Alka-Seltzer Alka-Seltzer 12ct 1292697 Original Original 12ct $3.50 Gas-X Chew Tab Gas-X Chew Tab 36ct 1196120 Peppermint Peppermint 36ct $7.50 Gas-X Extra Strength Cherry Crème 18ct Gas-X Extra Strength 1696657 Cherry Crème 18ct $6.00 Nexium 24-Hour Heartburn Relief 20mg Prevacid OTC 24-Hour Capsules Prilosec OTC 20mg Tab 14ct 4949434 14ct 4228979 14ct 3508264 Nexium 24-Hour Heartburn Relief 20mg Prevacid OTC 24-Hour Capsules Prilosec OTC 20mg Tab 14ct $15.00 14ct $16.50 14ct $17.00 4 Call Customer Service to order your OTC items

ANTACID / ACID REDUCERS Rolaids Extra Strength Chewable 96ct 4864161 Rolaids Extra Strength Chewable 96ct $6.00 Fruit Fruit Rolaids Regular Rolaids Regular Strength Chewable 150ct 4864211 Strength Chewable 150ct $6.00 Mint Mint Tagamet HB OTC 200mg 6ct Tagamet HB OTC 4810545 200mg 6ct $3.50 Tums Extra Strength Tums Extra Strength Smoothies Tab 60ct 3710092 Smoothies Tab 60ct $6.50 Assorted Fruit Assorted Fruit Zantac 75mg 10ct 2415958 Zantac 75mg 10ct $6.50 Zegerid OTC 20mg 14ct 4269395 Zegerid OTC 20mg 14ct $15.00 ANTI-DIARRHEAL 4081907 Anti-Diarrheal Caplet 24ct $5.50 Anti-Diarrheal Caplet 1363068 Anti-Diarrheal Caplet 12ct $3.50 Anti-Diarrheal Caplet Imodium A-D Liquid Cool Mint 4oz Imodium A-D Liquid 3638244 Cool Mint 4oz $7.50 Kaopectate Liquid Regular Flavor 8oz Kaopectate Liquid 4605168 Regular Flavor 8oz $6.00 ANTI-FUNGAL Athletes Antifungal Lamisil AT Athletes 4081683 0.5oz $10.50 2856060 Foot Cream Foot Cream 12gm $12.00 3397718 Clotrimazole 1% Cream 1oz $4.50 1887819 Lotrimin AF Cream 24gm $14.50 3508470 Miconazole Nitrate Cream 2% 30gm $6.50 Miconazole Nitrate Cream 2% 2534121 Tolnaftate 1% Cream 1oz $5.50 Tolnaftate 1% Cream 1026525 Tolnaftate 1% Powder 1.5oz $4.00 Tolnaftate 1% Powder Fungi Nail Tincture 30ml 1147065 Fungi Nail Tincture 30ml $14.50 Lamisil Defense Lamisil Defense 4.6oz 3704459 Spray Powder Spray Powder 4.6oz $8.50 Lotrimin AF Liquid Lotrimin AF Liquid 4.6oz 4889614 Spray Spray 4.6oz $9.00 Call Customer Service to order your OTC items 5

Lotrimin AF Powder Spray Mycocide NS Antimicrobial Sol ANTI-FUNGAL 4.6oz 3636883 1oz 1119841 ANTI-ITCH Lotrimin AF Powder Spray Mycocide NS Antimicrobial Sol 6 Call Customer Service to order your OTC items 4.6oz $9.00 1oz $16.00 9900662 Calamine Lotion 6oz $4.00 4829941 Caladryl Lotion 6oz $7.00 2372134 1021872 Diphenhydramine Cream 2% Hydrocortisone 1% Anti-Itch Cream Benadryl Regular Strength Itch Relief 1% Cream Cortizone-10 Intensive Healing Formula Anti-Itch Crème Gold Bond Medicated Maximum Strength Cream 1oz $4.50 2529717 1oz $4.50 4995825 1oz 2529709 1oz 4029112 1oz 1984046 Benadryl Extra Strength Itch Stopping 2% Cream Cortaid Anti-Itch Maximum Strength Cream 1% Benadryl Regular Strength Itch Relief 1% Cream Cortizone-10 Intensive Healing Formula Anti-Itch Crème Gold Bond Medicated Maximum Strength Cream 1oz $6.00 1oz $7.00 1oz $5.50 1oz $6.50 1oz $5.00 Psoriasin Ointment 4oz 4424255 Psoriasin Ointment 4oz $11.50 ANTISEPTIC OINTMENTS / CREAMS 2149250 Bacitracin Zinc Bacitracin Zinc 1oz $6.00 Ointment Ointment Triple Antibiotic Neosporin Original 4762878 1oz $7.50 1026434 Ointment Antibiotic Ointment 1oz $10.00 Bactine Liquid 4oz 1028760 Bactine Liquid 4oz $5.50 Neosporin Plus Maximum Strength Ointment Neosporin Plus Maximum Strength Ointment 0.5oz 4451555 1oz 1203504 Neosporin Plus Maximum Strength Ointment Neosporin Plus Maximum Strength Ointment 0.5oz $7.00 1oz $11.50

4807822 9900163 9900000 4371688 All Night Cold Original Liquid Effervescent Cold Relief Medicated Chest Rub Mucus Relief DM COLD / COUGH / FLU REMEDIES 8oz $5.50 4410890 Vicks NyQuil Liquid 8oz $10.00 20ct $5.50 4235339 Alka-Seltzer Plus Cold Effervescent Original 20ct $6.50 3.53oz $4.00 2972362 Vicks VapoRub 3.53oz $10.50 30ct $4.00 3592367 4371647 Mucus Relief 60ct $5.00 3459377 3653219 3695129 Sudogest PE Tab 10mg Tussin DM Sugar Free Liquid Clear 36ct $6.00 4oz $4.00 4485868 Mucinex DM Extended Release Mucinex Extended Release Sudogest PE Tab 10mg Robitussin DM Sugar Free Peak Cold Cough/Congestion 20ct $15.00 20ct $14.50 4oz $7.00 3454915 Tussin Form 8oz $5.00 Tussin Form Robitussin Peak 3706827 Tussin Form CF 8oz $5.00 4485769 Cold Max Multi- 4oz $8.50 Symptom Liquid Robitussin DM 1759349 Tussin Form DM 8oz $5.00 4427639 Peak Cold Cough/ 4oz $7.00 Congestion Alka-Seltzer Plus Alka-Seltzer Plus Cold Formula Cold Formula 36ct 4240206 Effervescent Effervescent 36ct $10.00 Original Original Chloraseptic Sore Throat Spray Menthol Contac Cold/Flu Day/Night Caplet Coricidin HBP Chest Congestion & Cough Liqui-Gels 6oz 1041318 28ct 4595310 20ct 3383619 Chloraseptic Sore Throat Spray Menthol Contac Cold/Flu Day/Night Caplet Coricidin HBP Chest Congestion & Cough Liqui-Gels 6oz $6.50 28ct $8.50 20ct $7.50 Call Customer Service to order your OTC items 7

Coricidin HBP Maximum Strength Flu Mucinex DM Maximum Strength Vicks DayQuil Liquid Capsules Vicks NyQuil Liquid Capsules COLD / COUGH / FLU REMEDIES Coricidin HBP 20ct 2947067 Maximum Strength Flu Mucinex DM 14ct 3989977 Maximum Strength 24ct Vicks DayQuil 4420766 Liquid Capsules 24ct 4410767 Vicks NyQuil Liquid Capsules 20ct $7.50 14ct $16.50 24ct $11.50 24ct $11.50 Vicks VapoRub 1.76oz 2972354 Vicks VapoRub 1.76oz $6.00 Vicks VapoRub 6oz 1274505 Vicks VapoRub 6oz $15.50 EAR CARE Debrox Drops Debrox Drops 0.5oz 4811857 Earwax Removal Aid Earwax Removal Aid 0.5oz $7.00 EYE CARE 1287648 Artificial Tears 0.5oz $8.00 Artificial Tears 2260040 Eye Drops 0.5oz $2.50 1133156 Visine Original Eye Drops 0.5oz $6.00 Bausch & Lomb Soothe Hydration Lubricant Eye Drops Clear Eyes Itchy Eye Relief Drops 15ml 4449708 0.5oz 3599412 Bausch & Lomb Soothe Hydration Lubricant Eye Drops Clear Eyes Itchy Eye Relief Drops 15ml $12.00 0.5oz $5.00 Refresh Liquigel 0.5oz 3286267 Refresh Liquigel 0.5oz $12.50 Thera Tears Sterilid Thera Tears Sterilid 1.62oz 3804671 Lid Scrub Lid Scrub 1.62oz $19.00 Visine A Drops 0.5oz 3952991 Visine A Drops 0.5oz $7.50 FIBER SUPPLEMENTS Fiber Laxative Fiber Laxative 9900364 100ct $10.50 Caplets Caplets 2566214 Fiberlax 90ct $7.00 1559285 FiberCon 90ct $16.00 2567832 Natural Fiber Powder 13oz $9.50 Natural Fiber Powder Metamucil Capsules 100ct 4590543 Metamucil Capsules 100ct $19.50 Metamucil Fiber Metamucil Fiber 24ct 4408878 Wafers Cinnamon Wafers Cinnamon 24ct $9.00 8 Call Customer Service to order your OTC items

FIRST AID SUPPLIES 1047281 Adhesive Fabric BAND-AID Flexible 30ct $3.50 1204890 Strips Assorted Fabric Assorted Sizes 30ct $4.00 3342177 Adhesive Pads Non- Adhesive Pads Non- 10ct $3.50 Stick Large 3in X 4in** Stick Large 3in X 4in** 2256915 Adhesive Sheer BAND-AID Comfort- 60ct $2.50 1675024 Strips Assorted Flex Sheer Assorted 60ct $3.50 Adhesive Tape Adhesive Tape 9900077 1ea $2.50 1/2in X 5yd** 1/2in X 5yd** Johnson & Johnson Adhesive Waterproof 2256865 1ea $3.00 1174028 Tape Waterproof Tape 1/2in X 10yd** 1/2in X 10yd** 1ea $5.00 4763371 Alcohol Prep Pads** 100ct $3.00 1237551 BD Alcohol Swabs** 100ct $3.50 3260080 Cotton Balls 300ct $4.00 Cotton Balls 9280058 Cotton Swabs 300ct $4.50 Cotton Swabs 1332113 Hydrogen Peroxide Hydrogen Peroxide 16oz $3.50 3% 3% Sterile Pads Johnson & Johnson 4756862 25ct $4.00 1134436 3in X 3in** Gauze 4in X 4in Pad** 25ct $8.50 4535811 Thermometer Digital Thermometer Digital 1ea $8.00 Flexible Tip Flexible Tip ACE Bandage Velcro ACE Bandage Velcro 1ea 1669886 2in 2in 1ea $5.00 ACE Bandage Velcro ACE Bandage Velcro 1ea 1669878 3in 3in 1ea $8.00 ACE Cold Compress ACE Cold Compress 1ea 1363159 Reusable Reusable 1ea $7.00 ACE Elastic Bandage ACE Elastic Bandage 1ea 1002054 3in 3in 1ea $8.00 BD Basic BD Basic 1ea 4543138 Thermometer Digitial Thermometer Digitial 1ea $5.00 Ice Bag 9in 1ea 1009349 Ice Bag 9in 1ea $9.50 Lanacane Antibacterial First Aid Spray Maximum Strength 3.5oz 4562286 Lanacane Antibacterial First Aid Spray Maximum Strength 3.5oz $7.50 Call Customer Service to order your OTC items 9

FIRST AID SUPPLIES Johnson & Johnson Johnson & Johnson 1ea 4476826 First Aid Kit 140 Items First Aid Kit 140 Items 1ea $13.50 New-Skin Liquid New-Skin Liquid 1oz 2167104 Bandage Bandage 1oz $6.00 Nexcare Comfort Nexcare Comfort 35ct 3483625 Strip 3/4in Strip 3/4in 35ct $3.00 Purell Hand Sanitizer 8oz 3659315 Purell Hand Sanitizer 8oz $4.00 Vaseline Petroleum Vaseline Petroleum 13oz 1217694 Jelly Jelly 13oz $6.00 Vicks Comfortflex Vicks Comfortflex 1ea 2867786 Thermometer Thermometer 1ea $15.50 FOOT CARE Dr. Scholl s Callous Dr. Scholl s Callous 1ea 2314151 Remover One Step Remover One Step 1ea $5.50 Dr. Scholl s Corn Remover Extra Thick Pads Dr. Scholl s Corn Cushion Regular 1ea 1085018 9ct 1038108 Dr. Scholl s Corn Remover Extra Thick Pads Dr. Scholl s Corn Cushion Regular 1ea $3.50 9ct $3.50 ID# PACK CONTAINS AMT HOME CARE KITS 999621 Cough Peak Max Multi- Symptom Cold And Pack Contains: Robitussin Peak CF Max Multi- Symptom Cold 4oz, BD Basic Oral Thermometer, $18.00 Fever Combo Acetaminophen 325mg 100ct Pack Contains: Eye Drops 0.5oz, Mack s Wax Away 999244 Ear Eye And Nose Combo $12.00 Removal System, Saline Nasal Spray 1.5oz Pack Contains: Hydrogen Peroxide 16oz, Triple 999826 First Aid Essentials Antibiotic Ointment 1oz, BAND-AID Flexible $15.00 Fabric Strips 30ct 999027 Hemorrhoid Care Combo Pack Contains: Tucks Pads 40ct, Hemorrhoidal Cream 1.8oz $11.50 999115 Oral Care Combo Pack Contains: Crest Toothpaste 3.6oz, Dental Floss 100yds, Toothbrush Full Head, Soft $7.50 999053 Pain Relief Combo Pack Contains: Arthritis Pain Reliever Caplets 50ct, Icy Hot Pain Relieving Cream 1.25oz $12.00 10 Call Customer Service to order your OTC items

HEMORRHOIDAL CARE Antiseptic Cleansing 4362869 Pads 100ct $6.00 1101237 Tucks Medicated Pads 100ct $10.00 9913268 Hemorrhoidal Cream 1.8oz $5.50 3621521 Preparation H Cream Maximum Strength 0.9oz $9.50 1633445 Hemorrhoidal Preparation H 12ct $5.00 1156850 Suppositories Suppositories 24ct $17.50 Preparation H Preparation H 2oz 1156835 Ointment Ointment 2oz $15.50 Tucks Medicated Pads 40ct 1101229 Tucks Medicated Pads 40ct $6.50 INCONTINENCE A&D Ointment 4oz 1219070 A&D Ointment 4oz $6.00 Balmex Clear Balmex Clear 3.5oz 3545092 Protection Ointment Protection Ointment 3.5oz $6.00 Balmex Diaper Rash Cream With Zinc 4oz Balmex Diaper Rash 2320794 Cream With Zinc 4oz $5.50 Oxide Oxide Desitin Ointment 2oz 1171875 Desitin Ointment 2oz $5.50 Fitted Briefs Extra Fitted Briefs Extra 15ct 4740585 Large (Diapers) Large (Diapers) 15ct $15.00 Fitted Briefs Large Fitted Briefs Large 18ct 4740536 (Diapers) (Diapers) 18ct $15.00 Fitted Briefs Fitted Briefs 16ct 4740551 Medium (Diapers) Medium (Diapers) 16ct $15.00 Perfit Protective Underwear Extra Large Perfit Protective Underwear Large Perfit Protective Underwear Medium Prevail Bladder Control Pads, Moderate Prevail Underpad (Bed Liners) 30in X 36in 14ct 4157053 18ct 4157012 20ct 4157004 20ct 3012762 25ct 4742458 Perfit Protective Underwear Extra Large Perfit Protective Underwear Large Perfit Protective Underwear Medium Prevail Bladder Control Pads, Moderate Prevail Underpad (Bed Liners) 30in X 36in 14ct $15.00 18ct $15.00 20ct $15.00 20ct $15.00 25ct $25.00 Call Customer Service to order your OTC items 11

Surecare Protective Underwear Extra Large Surecare Protective Underwear Large Surecare Protective Underwear Medium INCONTINENCE Surecare Protective 14ct 4494621 Underwear Extra Large 18ct Surecare Protective 4438008 Underwear Large Surecare Protective 18ct 4763892 Underwear Medium LACTOSE INTOLERANT 14ct $20.00 18ct $20.00 18ct $20.00 Lactaid Caplets 120ct 4418844 Lactaid Caplets 120ct $18.50 Lactaid Fast Act Lactaid Fast Act 32ct 3637964 Caplets Caplets 32ct $11.00 LAXATIVES 2362390 Bisacodyl 5mg 100ct $7.00 Bisacodyl 5mg 2362408 Bisacodyl 5mg 25ct $4.00 3323664 Dulcolax 5mg 25ct $8.00 4222527 Clearlax Powder 4.1oz $5.50 3919909 MiraLAX Pwd 7 doses 4.1oz $8.50 4222535 Clearlax Powder 8.3oz $13.50 3919917 MiraLAX Powder 8.3oz $15.00 1553338 Magnesium Citrate Magnesium Citrate 10oz $3.00 Cherry Cherry 1163260 Magnesium Citrate Magnesium Citrate 10oz $3.00 Lemon Lemon 3550779 Natural Laxative Plus Stool Softener 60ct $5.00 Natural Laxative Plus Stool Softener 3580743 Senna 100ct $6.00 1003565 Senokot -S 30ct $21.00 1470475 Stool Softener Stool Softener 100ct $4.50 Softgels Softgels Ex-Lax Pieces Ex-Lax Pieces 24ct 4064515 Regular Strength Regular Strength 24ct $6.00 Ex-Lax Ex-Lax 30ct 2617033 Regular Strength Regular Strength 30ct $7.50 Fleet Enema Adult 4.5oz 1098011 Fleet Enema Adult 4.5oz $4.00 Fleet Glycerin Fleet Glycerin 24ct 1025972 Suppository Suppository 24ct $3.50 12 Call Customer Service to order your OTC items

LICE TREATMENT Nix Control Spray Nix Control Spray 5oz 2879807 Pump Pump 5oz $8.00 Nix Lice Treatment Nix Lice Treatment 2oz 1827625 Creme Rinse Single Creme Rinse Single 2oz $14.00 Nix Lice Treatment 2oz x Nix Lice Treatment 2oz x 1827617 $23.00 Creme Rinse 2oz Creme Rinse 2oz LOZENGES Cough Drops Black Cough Drops Black 4562393 25ct $2.00 Cherry Sugar Free Cherry Sugar Free 4348082 Cough Drops Cherry 30ct Halls Mentho-Lyptus $2.00 2970994 Drops Cherry 30ct $3.00 4348199 Cough Drops Honey Halls Cough Drop 30ct $2.00 2971000 Lemon Honey Lemon 30ct $3.00 Cepacol Maximum Strength Lozenge 16ct Cepacol Maximum 4972725 Strength Lozenge 16ct $4.00 Honey Lemon Honey Lemon Halls Defense Halls Defense Vitamin C Drops Vitamin C Drops 25ct 3662343 Sugar Free Assorted Sugar Free Assorted 25ct $3.00 Citrus Citrus Halls Defense Zinc Drops Harvest 25ct 2971125 Halls Defense Zinc Drops Harvest 25ct $3.00 Cherry Cherry MISCELLANEOUS CARE** Lumiscope Self- Lumiscope Self- Taking Blood Taking Blood 1ea 2158566 Pressure Kit With Pressure Kit With 1ea $17.50 Stethoscope Stethoscope MOTION SICKNESS 1200336 Motion Sickness Tab 12ct $2.50 4583258 Dramamine 50mg 12ct $5.50 Bonine 8ct 4489688 Bonine 8ct $4.50 ORAL CARE 9900441 Dental Floss 100yd 1ea $2.50 Dental Floss 100yd Dental Floss Mint Dental Floss Mint 9900440 1ea $2.50 Waxed 100yd Waxed 100yd 1123272 Toothbrush Full Head Soft 1ea $1.50 Toothbrush Full Head Soft Call Customer Service to order your OTC items 13

ORAL CARE Anbesol Gel Regular Anbesol Gel Regular 0.33oz 3031879 Strength Cool Mint Strength Cool Mint 0.33oz $7.00 Anbesol Liquid Regular Strength 0.41oz Anbesol Liquid 3677994 Regular Strength 0.41oz $7.00 Cool Mint Cool Mint Colgate Toothpaste Colgate Toothpaste 8.2oz 1236058 Regular Super Regular Super 8.2oz $5.00 Efferdent Denture Efferdent Denture 40ct 1359454 Cleanser Cleanser 40ct $4.00 Fixodent Denture Adhesive Cream 2.5oz 1179100 Fixodent Denture Adhesive Cream 2.5oz $7.00 Original Original Fixodent Fresh 2.5oz 1831072 Fixodent Fresh 2.5oz $7.00 Orajel Maximum Orajel Maximum 0.25oz 1033471 Strength Gel Strength Gel 0.25oz $7.00 Orajel Mouth Sore Orajel Mouth Sore 0.18oz 1529403 Gel Gel 0.18oz $6.50 Polident 3 Minute Polident 3 Minute 120ct 4575304 120ct $10.00 Polident Overnight Polident Overnight 120ct 4575296 Cleanser Cleanser 120ct $10.00 Sea-Bond Denture Adhesive Lowers Original 15ea 1138809 Sea-Bond Denture Adhesive Lowers Original 15ea $4.00 Sea-Bond Denture Adhesive Uppers Original Sensodyne Toothpaste Original Flavor Super Poligrip Denture Adhesive Cream Zinc Free Formula Toothpaste Crest Large 15ea 1138932 4oz 1089689 2.4oz 4300133 4.6oz 1185313 Sea-Bond Denture Adhesive Uppers Original Sensodyne Toothpaste Original Flavor Super Poligrip Denture Adhesive Cream Zinc Free Formula Toothpaste Crest Large 15ea $4.00 4oz $7.50 2.4oz $7.50 4.6oz $3.50 14 Call Customer Service to order your OTC items

PAIN RELIEVERS 2525855 Acetaminophen Tylenol 325mg 100ct $4.50 1296250 325mg 100ct $11.00 2525871 Acetaminophen Extra Strength 500mg 100ct $5.00 1331958 Tylenol Extra Strength 500mg 100ct $14.50 Caplets Acetaminophen Acetaminophen 3956810 Extra Strength Rapid 100ct $7.50 Extra Strength Rapid Release Gels 500mg Release Gels 500mg Arthritis Pain Relief Arthritis Pain Relief 2940625 50ct $7.50 Caplet Caplet 2749588 Aspirin 325mg 100ct $3.50 4212866 Bayer 325mg 100ct $9.50 3998192 Bayer Adult 81mg Aspirin Adult Enteric 120ct $3.50 4212809 Enteric Coated Low Coated 81mg Dose Aspirin 120ct $10.00 Aspirin Child Chew Bayer Child Chew 1498807 36ct $2.00 1366830 81mg Aspirin Low Dose 36ct $3.50 3679529 2164226 2291243 1783547 3035771 4086849 9914581 4596680 2163442 Aspirin Enteric Coated 325mg Headache Relief Added Strength Ibuprofen 200mg Caplet Ibuprofen 200mg Caplet Ibuprofen 200mg Ibuprofen Child Susp Berry Migraine Relief Caplet Naproxen Sodium Caplet Non-Aspirin Child Chewable 80mg Fruit 125ct $4.00 4810636 100ct $5.50 Ecotrin 325mg Regular Strength Headache Relief Added Strength 125ct $9.00 100ct $6.00 1110543 Advil 200mg Caplet 100ct $14.50 50ct $3.00 1110568 Advil 200mg Caplets 50ct $9.00 100ct $6.00 1330505 Advil 200mg 100ct $14.50 4oz $5.00 2488237 24ct $4.00 Advil Child Suspension Fruit Migraine Relief Caplet 4oz $7.50 100ct $9.00 2190874 Aleve 220mg Caplet 100ct $15.00 30ct $4.00 Non-Aspirin Child Chewable 80mg Fruit Call Customer Service to order your OTC items 15

PAIN RELIEVERS 4760310 Pain Reliever PM Pain Reliever PM 50ct $4.00 Extra Strength Caplet Extra Strength Caplet 7180078 Sleep Aid 16ct $3.50 Sleep Aid Advil 200mg Gel Advil 200mg Gel 24ct 2384238 Caplets Caplets 24ct $5.50 Advil 200mg Liqui-Gel 80ct 2764959 Advil 200mg Liqui-Gel 80ct $16.00 Advil 200mg Liqui-Gel 20ct 2764934 Advil 200mg Liqui-Gel 20ct $6.00 Advil 200mg Advil 200mg 20ct 2947406 Migraine Liqui-Gels Migraine Liqui-Gels 20ct $6.00 Advil 200mg 24ct 1330471 Advil 200mg 24ct $5.50 Advil 200mg Advil 200mg 150ct 3779477 EZ Open EZ Open 150ct $19.00 Advil PM Caplet 40ct 3725611 Advil PM Caplet 40ct $10.50 Aleve 220mg Arthritis Aleve 220mg Arthritis 40ct 4212783 Gelcaps Easy Open Gelcaps Easy Open 40ct $9.50 Aleve 220mg Caplets 50ct 2190858 Aleve 220mg Caplets 50ct $9.50 Aleve 220mg Caplets 24ct 2190833 Aleve 220mg Caplets 24ct $5.50 Aleve 220mg Liqu-Gels 40ct 3807260 Aleve 220mg Liqu-Gels 40ct $12.00 Aleve 220mg 24ct 2190825 Aleve 220mg 24ct $5.50 Aleve 220mg 100ct 2190866 Aleve 220mg 100ct $15.00 Anacin 100ct 1156512 Anacin 100ct $11.50 Bayer 325mg 200ct 4212882 Bayer 325mg 200ct $14.00 BC Arthritis Powder 24ct 4849196 BC Arthritis Powder 24ct $5.00 BC Headache Powder 24ct 4849139 BC Headache Powder 24ct $5.00 Midol Maximum Midol Maximum Strength Menstrual Form Caplet 24ct 2612778 Strength Menstrual Form Caplet 24ct $7.00 Midol Maximum Strength Menstrual Form Gelcap Motrin IB 200mg Caplet Pamprin Cramp Max Relief Caplet Pamprin Multi- Symptom Caplets 24ct 2715464 100ct 1752898 16ct 1027267 20ct 2364834 Midol Maximum Strength Menstrual Form Gelcap Motrin IB 200mg Caplet Pamprin Cramp Max Relief Caplet Pamprin Multi- Symptom Caplets 16 Call Customer Service to order your OTC items 24ct $7.00 100ct $13.50 16ct $4.50 20ct $5.00

St. Joseph Adult Aspirin 81mg Chew Tab Tylenol Extra Strength 500mg Caplets PAIN RELIEVERS St. Joseph Adult 36ct 4379871 Aspirin 81mg Chew Tab Tylenol Extra 24ct 2331908 Strength 500mg Caplets SKIN CARE / SUNSCREEN 8oz Banana Boat Sport 4251906 Sunblock SPF 30 Banana Boat 6oz 4799995 Ultramist Sport Clear SPF 50 36ct $3.50 24ct $5.00 Banana Boat Sport Sunblock SPF 30 8oz $10.50 Banana Boat Ultramist Sport Clear 6oz $12.00 SPF 50 SMOKING CESSATION 3666583 Nicotine Gum 2mg 50ct $25.00 Nicotine Gum 2mg 3593225 Nicotine Gum 4mg 50ct $25.00 Nicotine Gum 4mg 3733920 3734118 3734092 Nicotine Patch Step 1 21mg Nicotine Patch Step 2 14mg Nicotine Patch Step 3 7mg Futuro Ankle Support Wrap Around Medium Futuro Ankle Support Wrap Around Large Futuro Knee Support Stabilizing Large Futuro Knee Support Stabilizing Medium Jobst Women s Sheer Knee High 8-15mmHg Medium Silky Beige Jobst Women s Sheer Knee High 8-15mmHg Small Silky Beige 7ct $24.50 Nicotine Patch Step 1 21mg 7ct $24.50 Nicotine Patch Step 2 14mg 7ct $24.50 Nicotine Patch Step 3 7mg SUPPORT 1ea Futuro Ankle Support 3936366 Wrap Around Medium 1ea 3936374 Futuro Ankle Support Wrap Around Large 1ea Futuro Knee Support 3498516 Stabilizing Large Futuro Knee Support 1ea 3498508 Stabilizing Medium Jobst Women s 1ea 2952414 Sheer Knee High 8-15mmHg Medium Silky Beige Jobst Women s Sheer 1ea 2952406 Knee High 8-15mmHg Small Silky Beige 1ea $10.50 1ea $10.50 1ea $15.50 1ea $15.50 1ea $13.00 1ea $13.00 Call Customer Service to order your OTC items 17

TOPICAL Muscle Rub Ultra Bengay Pain Relieving 2987865 2oz $4.00 2308583 Strength Cream Ultra Strength 2oz $7.00 Abreva Cold Sore Abreva Cold Sore 2gm 2986651 Cream Cream 2gm $24.50 Activon Ultra Strength Arthritis 2oz Activon Ultra 3878014 Strength Arthritis 2oz $11.50 Topical Analgesic Topical Analgesic Aspercreme Heat Aspercreme Heat 2.5oz 4020004 Pain Relieving Gel Pain Relieving Gel 2.5oz $7.00 Aspercreme Pain Aspercreme Pain 3oz 1241249 Relieving Rub Relieving Rub 3oz $7.00 Bengay Pain Relieving Cream Ultra 4oz Bengay Pain 2308591 Relieving Cream Ultra 4oz $10.00 Strength Strength Bengay Ultra Bengay Ultra Strength Pain Strength Pain 5ct 3577418 Relieving Patch Reg Relieving Patch Reg 5ct $9.50 Size Size Bengay Vanishing Bengay Vanishing 2oz 2308534 Scent Rub Scent Rub 2oz $5.50 Capzasin Topical Analgesic Liquid No- 1oz Capzasin Topical 3934254 Analgesic Liquid No- 1oz $10.00 Mess Applicator Mess Applicator Icy Hot Balm 3.5oz 1021112 Icy Hot Balm 3.5oz $7.00 Icy Hot Cream 1.25oz 1141878 Icy Hot Cream 1.25oz $5.00 Icy Hot Medicated Icy Hot Medicated Patches Extra 5ct 3485984 Patches Extra 5ct $8.50 Strength Large (Back) Strength Large (Back) Icy Hot Patches Icy Hot Patches 5ct 3011889 Arm/Neck/Leg Arm/Neck/Leg 5ct $7.00 Icy Hot Sleeve Large Icy Hot Sleeve Large 3ct 3549649 Knee/Ankle/Elbow Knee/Ankle/Elbow 3ct $8.00 Stopain (Now Cryoderm ) SX 10% MSM Pain Relief Spray 4oz 4878468 Stopain (Now Cryoderm ) SX 10% MSM Pain Relief Spray 4oz $11.50 18 Call Customer Service to order your OTC items

2470433 3379666 ThermaCare Heatwraps 8HR Lower Back & Hip ThermaCare Heatwraps 8HR Neck/ Shoulder/Wrist ThermaCare Heatwraps Menstrual Zostrix High Potency Arthritis Pain Relief Cream Zostrix Original Strength Arthritis Pain Relief Cream Miconazole 7 Vaginal Cream Miconazole 7 Vaginal Suppositories Monistat 3 Cream Prefilled Applicator 3ct Vagistat-3 Combination Pack TOPICAL ThermaCare 2ct 3296340 Heatwraps 8HR Lower Back & Hip ThermaCare 3ct 3296365 Heatwraps 8HR Neck/ Shoulder/Wrist 3ct 4264628 ThermaCare Heatwraps Menstrual Zostrix High Potency 2oz 2307304 Arthritis Pain Relief Cream Zostrix Original 2oz 3396918 Strength Arthritis Pain Relief Cream VAGINAL Monistat 7 Cream 45gm $10.50 4725487 With Disposable Applicator 7ct $6.00 Miconazole 7 Vaginal Suppositories Monistat 3 Cream 3ct 4738936 Prefilled Applicator 3ct 1ea 4008520 Vagistat-3 Combination Pack VITAMINS 60ct $5.00 Caltrate 600mg + D 4604971 60ct $6.00 Cerovite Senior 100ct $6.00 Ferrous Sulfate 325mg Call Customer Service to order your OTC items 19 2ct $9.50 3ct $9.50 3ct $9.50 2oz $22.00 2oz $18.00 1.59oz $13.50 3ct $18.50 1ea $13.00 Calcium Carbonate 2200285 600mg + D 60ct $10.50 1121797 Cerovite Senior 3671534 Ferrous Sulfate 325mg 2461689 Oyst-Cal + D 500mg 60ct $3.50 Oyst-Cal + D 500mg 2204881 Prosight 60ct $8.50 Prosight Vitamin B-12 500mcg Vitamin B-12 500mcg 3662608 100ct $5.50 3070679 Vitamin C 500mg 250ct $11.00 Vitamin C 500mg

VITAMINS 1715473 Vitamin D Tab 400IU 100ct $5.00 Vitamin D Tab 400IU Vitamin E 400IU Vitamin E 400IU 2162998 100ct $11.50 Softgel Softgel 3123247 Windmill Vitamin A Windmill Vitamin A 100ct $5.50 10000IU Softgel 10000IU Softgel Windmill Vitamin 3108404 B Complex With 100ct $8.00 Windmill Vitamin B Complex With Vitamin C + Iron Vitamin C + Iron 3123239 Windmill Calcium Windmill Calcium 60ct $6.50 Chewable 500mg Tab Chewable 500mg Tab Windmill Folic Acid Windmill Folic Acid 3069549 180ct $6.50 400mcg Tabs 400mcg Tabs Centrum Silver 50+ Centrum Silver 50+ 100ct 4163507 Ultra Men s Ultra Men s 100ct $15.50 Centrum Silver Centrum Silver 60ct 3651502 Chewable Chewable 60ct $16.50 Centrum Silver 50+ Centrum Silver 50+ 100ct 4967014 Ultra Women s Ultra Women s 100ct $15.50 Ester-C 500mg Ester-C 500mg 60ct 3915196 60ct $8.50 Ocuvite 60ct 1753490 Ocuvite 60ct $11.50 Viactiv Calcium Viactiv Calcium 60ct 4898375 Chew Carmel + D Chew Carmel + D 60ct $10.00 Viactiv Calcium Chew Milk Chocolate + D Vitafusion B Complex Chew Energy 60ct 4898383 70ct 4829388 Viactiv Calcium Chew Milk Chocolate + D Vitafusion B Complex Chew Energy 60ct $10.00 70ct $5.00 WART REMOVAL Compound W Fast- Compound W Fast- 0.31oz 1156603 Acting Liquid Acting Liquid 0.31oz $9.50 Compound W Gel 0.25oz 1047471 Compound W Gel 0.25oz $9.50 Dr. Scholl s Clear Dr. Scholl s Clear Away One Step Wart Remover 1ea 1963636 Away One Step Wart Remover 1ea $9.50 20 Call Customer Service to order your OTC items

Easy Choice Health Plan Easy Choice Health Plan allows for the submission of retail receipts for items purchased that follow the Centers for Medicare & Medicaid Services (CMS) guidelines. Our catalog is representative of these types of items. Please refer to the catalog for the listings of items that are eligible for reimbursement and those that are not. Receipt totals will be deducted from the member s monthly benefit allowance for the month in which the purchase occurred. If the member s monthly benefit allowance has been exhausted, the request for reimbursement will be denied. To have a receipt reimbursement form sent to you, call 1-877-483-9563, TTY 711, Monday-Friday, 6:30 a.m. 8:00 p.m. Pacific. Or visit www.easychoicehealthplan.com to print the form. Completed forms should be mailed to: Drug Source PO.. Box 1366 Elk Grove Village, IL 60009-9917 Please allow 30 days from the date the receipt and form were received for payment. For a list of eligible items, please refer to this catalog. Call Customer Service to order your OTC items 21

We re always just a phone call away! If you re ready to enroll or have enrollment questions, call 1-866-999-3945, 8 a.m. to 8 p.m., 7 days a week. If you re already a member, call the number for your state/plan listed below. California: All Plans...1-866-999-3945 Hours of operation are Monday Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are available Monday Sunday, 8 a.m. to 8 p.m., or visit us anytime at www.easychoicehealthplan.com. Nurse Advice Line... 1-800-581-9952 (24 hours, 7 days a week) TTY for all of the above...1-800-735-2929

Easy Choice Health Plan, a WellCare company, (HMO/HMO SNP) is a Medicare Advantage organization with a Medicare contract and a contract with the California Medicaid program. Enrollment in Easy Choice (HMO/HMO SNP) depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, co-payments and restrictions may apply. Benefits, premium and/ or co-payments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Please contact Easy Choice for details. P.O. Box 31389 Tampa, FL 33631-3389 62089